MANUAL OF INSTRUCTIONS 

for 
School Authorities and 
School Physicians. 




Class. 



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Book X(o ft t> 
191 i 



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MANUAL OF INSTRUCTIONS 



FOR 



School Authorities and 
School Physicians 



Issued jointly by the Indiana State Board of Education 
and the Indiana State Board of Health, as provided 
in Section 5 of the Medical School Inspec- 
tion Law, approved March 6, 1911 



CHAS. A. GREATHOUSE, 

President State Board of Education 

[SEAL] 



J. N. HURTY, 

S«cretary State Board of Health 

[SEAL] 



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4 



-33 2. 



MANUAL OF INSTRUCTIONS 



SCHOOL AUTHORITIES AND 
SCHOOL PHYSICIANS 



Issued jointly by the Indiana State Board of Education and the Indiana 

State Board of Health, as provided in Section 5 of the Medical 

School Inspection Law, approved March 6, 1911 



CHAS. A. GREATHOUSE, J. N. HURTY, 

President State Board of Education Secretary State Board of Health 

[seal] [seal] 



INDIANAPOLIS : 

WM. B. BURFORD, CONTRACTOR FOR STATE PRINTING AND BINDING 
1911 



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TABLE OF CONTENTS 



Page 

Medical School Inspection Law IS 

Sanitary Schoolhouse Law 6 

Rules for Quarantine and Exclusion from School 11 

Directions for Disinfection , 1.5 

Rules for the Medical Inspector , . . 21 

Rules for the Teacher 22 

Blank Forms ..... .25-31 

Teaching of Hygiene • • 31 

Comments on Sanitary Schoolhouse Law 32 



6 \%n 



(2) 



INTRODUCTION, 



The most valuable asset that any child can possess is good 
health. The health of the child very largely determines the suc- 
cess of the adult, and what we should be most concerned about 
in education is the laying up of vital assets for. use in the active 
battle of life. One of the most commonplace of our proverbs 
tells us that : ' * Prevention is better than cure, ' ' yet it has here- 
tofore been with the greatest difficulty that the public could be 
convinced that the prevention of defects in school children is 
better than their cure. 

The State of Indiana has taken a forward step in providing 
by law for the erection of sanitary schoolhouses and for medical in- 
spection of school children, and it will not be long until every 
school which makes any claim to progressiveness is provided with 
intelligent supervision of the health conditions of its pupils. 

This manual is intended to cover in a brief way all the essen- 
tials necessary in the beginning of medical school inspection. No 
comprehensive plan can be outlined that will meet the needs of 
every school community. Medical inspection must be established 
in the different school communities of the State and worked out 
along lines that will meet the local conditions. So far as pos- 
sible, it is the aim of this manual to have the fundamental prin- 
ciples of sehool inspection carried out uniformly throughout the 
State. Hence the rules herein set forth have been made as simple 
and plain as possible. The institution of medical inspection by 
the Act of 1911 must be regarded not only as an attempt to safe- 
guard the lives and health of the pupils in our public schools, 
but is also a foreshadowing of better things to come." The legis- 
lature has done its part and has prepared the way. It now rests 
with school and health officials to realize their responsibilies. to 
arouse public sentiment from its present state of apathy and by 
fulfilling the spirit as well as the letter of the law to develop the 
scheme of medical inspection into an efficient system of preven- 
tion. 

Administrative expenditure of this kind is the soundest econ- 
omy. No higher work can be conceived than that of conserving 

(3) 



and safeguarding the health and lives of the children in the public 
schools of Indiana. As has been well said by David Starr Jordan : 

"There is nothing in all the world so important as little children, 
nothing so interesting. If ever you wish to go in for philanthropy, if ever 
you wish to be of any real use in. the world, do something for children. We 
can dress the sore, bandage the wounded, imprison the criminal, heal the 
sick and bury the dead, but there is always the chance that we can save 
the child. If the great army of philanthropists ever exterminate sin and 
pestilence, ever work out our race's salvation, it will be because a little 
child has led them." 



THE SCHOOLS AND HEALTH. 



That health is an asset is now realized by every one. It is a 
crime for anyone to suffer from a curable or preventable disease. 
Since the strength of a State depends upon the strength and char- 
acter of its citizens, it becomes the duty of the State for its own 
protection to safeguard the health of its own people. It would 
seem that in no other place can this duty of the State be more 
fully met than in protecting and safeguarding the health of its 
future citizens in the public schools. It would seem also that a 
compulsory education law ought to be preceded by a law providing 
for the health and care of young people. Since such a law was 
not enacted before the compulsory education law, the legislature 
of 1911 very wisely enacted the Sanitary Schoolhouse Law, which 
follows. This law marks an advanced step, in the educational 
system of Indiana and will do much to conserve the health and 
normal physical development of the pupils in the public schools, 
as well as to increase the efficiency of school work. 



THE SANITARY SCHOOLHOUSE LAW. 



AN ACT entitled an act to protect the health and lives of school children, 
and increase their efficiency, by providing healthful schoolhouses, and 
requiring the teaching of hygiene. 

(S. 28. Approved March 1, 1911.) 
Schools — Sanitary Buildings. 

Section 1. Be it enacted by the General Assembly of the State 
of Indiana, That after the going into effect of this act, all school- 
houses which shall be constructed or remodeled, shall be con- 
structed in accordance and conform to the following sanitary 
principles, to-wit : 

(a) Sites. All sites shall be dry, and such drainage as may 
be necessary to secure and maintain dry grounds and dry build- 
ings, shall be selected and supplied. Said site and said buildings 
shall not be nearer than 500 feet to steam railroads, livery stables, 
horse, mule or cattle barn used for breeding purposes, or any un- 
healthful conditions. Good dry walks shall lead from the street 
or road to every schoolhouse and to all outhouses, and suitable 
playgrounds shall be provided. 

(b) Buildings. School buildings, if of brick, shall have a 
stone foundation, or the foundation may be of brick, or concrete: 
Provided, A layer of slate, stone or other impervious material be 
interposed above the ground line, or the foundation may be of 
vitrified brick and the layer of impervious material will not be 
required. Every two-story schoolhouse shall have a dry, well- 
lighted basement under the entire building, said basement to have 
a cement or concrete floor and ceiling to be not less than ten feet 
above the floor level. The ground floor of all schoolhouses shall 
be raised at least three feet above the ground level and have, when 
possible, dry, well-lighted basement under the entire building, and 
shall have a solid foundation of brick, tile, stone or concrete, and 
the area between the ground and the floor shall be thoroughly ven- 
tilated. Each pupil shall be provided with not less than 225 cubic 
feet of space, and the interior walls and ceiling shall be either 
painted or tinted some neutral color, as gray, slate, buff or green. 

(c) Lighting and Seating. All schoolrooms w.here pupils are 
seated for study, shall be lighted from one side only and the glass 

(6). 



area shall be not less than one-sixth of the floor area and the win- 
dows shall extend from not less than four feet from the floor to at 
least one foot from the ceiling, all windows to be provided with 
roller or adjustable shades of neutral color, as blue, gray, slate, 
buff or green. Desks and desk seats shall preferably be adjust- 
able, and at least twenty per cent, of all desks and desk seats in 
each room shall be adjustable, and shall be so placed that the light 
shall fall over the left shoulders of the pupils. For left-handed 
pupils desks and seats may be placed so as to permit the light to 
fall over the right shoulder. 

(d) Blackboards and Cloakrooms. Blackboards shall be pref- 
erably of slate, but of whatever material, the color shall be a dead 
black. Cloakrooms, well lighted, warmed and ventilated, or sani- 
tary lockers, shall be provided for each study schoolroom. 

(e) Water Supply and Drinking Arrangements. All school- 
houses shall be supplied with pure drinking water and the water 
supply shall be from driven wells or other source approved by the 
health authorities. Only smooth, stout glass or enameled metal 
drinking cups shall be used; water buckets and tin drinking cups 
shall be unlawful and are forbidden ; and whenever it is prac- 
ticable, flowing sanitary drinking fountains which do not require 
drinking cups, shall be provided. All schoolhouse wells and pumps 
shall be supplied with troughs or drains to take away waste water, 
and under no conditions shall pools or sodden places or small or 
large mudholes be allowed to exist near a well. When water is not 
supplied at pumps or from water faucets or sanitary drinking 
fountains, then covered tanks or coolers supplied with spring or 
self-closing faucets shall be provided. 

(f) Heating and Ventilation. Ventilating heating stoves, fur- 
naces, and heaters of all kinds, shall be capable of maintaining a 
temperature of 70 degrees Fahrenheit in zero weather and of main- 
taining a relative humidity of at least 40 per cent., and said heaters 
of all kinds shall take air from outside the building and after 
heating, introduce it into the schoolroom at a point not less than 
five nor more than seven feet from the floor, and at a minimum 
rate of thirty (30) cubic feet per minute for each pupil, provided, 
that when direct-indirect steam heating is adopted, this provision 
as to height of entrance of hot air shall not apply. Halls, office 
rooms, laboratories and manual training rooms may have direct 
steam radiators, but direct steam heating is forbidden for study 
schoolrooms, and direct-indirect steam heating is permitted. All 



8 

schoolrooms shall be provided with ventilating ducts of ample size 
to withdraw the air at least four times every hour, and said ducts 
and their openings shall be on the same side of the room with the 
hot air ducts. 

(g) Water-closets and Outhouses. Water-closets or dry closets 
when provided, shall be efficient and sanitary in every particular 
and furnished with stalls for each hopper or place; and when said 
water or dry closets are not provided, then sanitary outhouses, well 
separated for the sexes, shall be provided. Good dry walks shall 
lead to all outhouses and screens or shields be built in front of 
them. Outhouses for males shall have urinals arranged with stalls 
and with conduits of galvanized iron, vitrified drain pipe, or other 
impervious material, draining into a sewer, vault or other suitable 
place, approved by the health authorities. Any school trustee or 
trustees who shall build or construct any schoolhouse or cause to 
be built or constructed any schoolhouse which does not include each 
and every sanitary provision commanded in this act, shall, upon 
conviction, be fined in any sum not less than one hundred nor more 
than five hundred dollars ; and any money claim for the material 
entering into, or any money claim for the construction of any 
schoolhouse which does not in every way and all respects comply 
with the requirements of this act shall be null and void. 

Temperature— Uncleanliness — Teachers — Penalties. 

Sec. 2. Whenever, from any cause, the temperature of a school- 
room falls to 60 degrees Fahrenheit or below, without the imme- 
diate prospect of the proper temperature, namely, not less than 
70 degrees Fahrenheit, being attained, the teacher shall dismiss the 
school until the fault is corrected ; and it shall also be the duty of 
all teachers to immediately send home any pupil who is perceptibly 
ill in any way, or who is unclean and emits offensive bodily odors 
or who is infested with lice or other vermin ; and the truant officer 
shall arrest and prosecute parent or guardians who do not rid their 
children of vermin and bodily uncleanliness, when notified to do so. 
Refusal of parents or guardians to free their children or wards 
of vermin or to bathe and cleanse them, making them fit to go to 
school, shall be punished by a fine of not less than five dollars and 
imprisonment for ten days or both. And if the refusal or neglect 
of parents or guardians to bathe and cleanse their children or wards 
makes it necessary, then the truant officer, upon order of the school 
authorities, shall have it done, the cost to be paid by the school 



authorities from the school funds. Whenever diphtheria, scarlet 
fever or other contagious and infectious diseases break out in any 
school it shall be the duty of the township trustee, school board, 
school trustee or the school authority or authorities having control, 
to have medical inspection made of the pupils, and all found in any 
degree ill shall be sent home and there retained until the local 
health officer gives a certificate of health, then such child may be 
again admitted to school. It shall be unlawful for school authorities 
to employ teachers or janitors who are not able-bodied or who are 
addicted to drugs or intemperate, or who have tuberculosis or 
syphilis. All schoolhouses shall be specially cleaned and disin- 
fected each year before they are used for school purposes. The 
cleaning shall consist in first sweeping, then scrubbing the floors, 
washing the windows and all woodwork, including the wooden 
parts of seats and desks, and the disinfecting shall be done in ac- 
cordance with the rules of the State board of health. Township 
trustees, school boards and boards of school commissioners who 
neglect or refuse to obey the provisions of this section shall be fined 
in any sum of not less than ten nor more than one hundred dol- 
lars, and each said refusal or neglect shall constitute a separate 
offense. 

Hygiene and Sanitary Science — Printed Data. 

Sec. 3. There shall be taught in each year in the fifth grade of 
every public school in Indiana, the primary principles of hygiene 
and sanitary science, and especially shall instruction be imparted 
concerning the principal modes by which each of the dangerous, 
communicable diseases are spread, and the best sanitary methods 
for the restriction and prevention of each such disease. Hygiene 
may also be taught in other grades at the will of school authorities. 
The State health commissioner and the State superintendent of 
public instruction shall jointly write, compile or originate printed 
data in leaflet form, setting forth as plainly as possible, the pri- 
mary principles of hygiene and sanitary science, and information 
concerning the prevention of diseases, and supply the same to all 
county superintendents, and said superintendents shall supply all 
the schools in their respective counties and see to it that teachers do 
not fail to comply with this section ; Provided, That for all cities 
and towns having school superintendents, the said leaflets and 
pamphlets shall be sent direct to such superintendents, who shall 
see to it that teachers comply with this section. The State printing 



10 

board shall publish from its funds all health leaflets or pamphlets 
as are herein provided for, and shall also pay the cost of distribu- 
tion of the same to the county, city or town superintendents, from 
the State printing funds. 

School Officers — Powers. 

Sec. 4. For the purpose of enforcing this act and making it 
practical, township trustees, boards of school trustees and boards of 
school commissioners shall have the power, and it is herewith made 
lawful for said trustees and said boards to make a levy not to ex- 
ceed five cents (5 cents) on each one hundred dollars ($100.00), 
the sum thus raised to be added to the special school fund, but to 
be used only for building and furnishing of schoolhouses. This 
levy shall not be made unless plainly necessary. 

Penalty as to Officers. 

Sec. 5. Any township trustee or the members of any board of 
school trustees or any teacher or any person who violates any pro- 
vision of this^act, except as herewith or otherwise provided, shall 
upon conviction, be fined not less than $50.00. 

Repeal. 
Sec. 6. All laws in conflict with this act are repealed. 



INDIANA STATE BOARD OF HEALTH RULES GOVERN- 

ING QUARANTINE AND EXCLUSION 

FROM SCHOOLS. 



Rule 1. The infectious and contagious diseases which shall be 
immediately reported to the health officer having jurisdiction and 
which shall be quarantined are hereby declared to be : Yellow fever, 
smallpox, cholera, diphtheria, membranous croup, scarlatina (scar- 
let fever), measles, typhus fever, bubonic plague, leprosy, cerebro- 
spinal meningitis, poliomyelitis, pulmonary consumption, typhoid 
fever, chickenpox and whooping cough. Provided, Pulmonary 
consumption and typhoid fever shall not be quarantined, but are 
to be reported for record only. And chickenpox, whooping 
cough and measles shall be carded to warn the public, absolute 
quarantine not being required. When quarantine has been estab- 
lished as provided by law the quarantine card or flag shall remain 
in place until after the patient has been removed from such house 
or has recovered and is no longer capable of communicating the 
disease, and the house and contents thereof have been properly dis- 
infected by order of the health officer having jurisdiction. 

Rule 2. Every physician attending a person affected with any 
quarantinable disease shall use every precaution to prevent com- 
municating the disease to others. To this end the board recom- 
mends that a cap and gown, linen duster, rubber coat or other 
sufficient cover for the clothing be worn. Before leaving the prem- 
ises the hands, and face should be cleansed with soap and water 
and a disinfecting solution. The coat, cap, antiseptic soap and 
bottle of disinfectant should be carried in a special receptacle 
which should contain a piece of cotton constantly wet with formal- 
dehyde. Health officers and attending physicians should give full 
and explicit instructions to parents, nurses and attendants con- 
cerning every precaution to be taken against the spread of in- 
fectious disease. 

Rule 3. Any house or building and its contents in which a case 
of quarantinable disease, and including tuberculosis and typhoid 
fever, has occurred shall be disinfected under the supervision of 
the health officer having jurisdiction, or his deputy, in accordance 
with the rules of the State board of health. 



12 

Rule 4. The minimum period of isolation, quarantine and ex- 
clusion from school in contagious diseases shall be as follows: 

SMALLPOX. For the patient, quarantine for not less than twenty- 
one (21) days after the beginning of the disease and until all crusts and 
scales have fallen off or been removed, and the disinfection of patient, 
clothing and premises. For exposed persons, quarantine for fourteen (14) 
days from date of last exposure unless successfully vaccinated or pro- 
tected by a previous attack of the disease, and person and clothing have 
been disinfected : Provided. That persons who have not been previously 
vaccinated and who shall submit to vaccination may be released from 
quarantine after disinfection of person and clothing when It has been shown 
that such vaccination is successful. Exclusion from school for seven (7) 
days following the removal of quarantine. 

SCARLET FEVER. For the patient and children in the family witli 
the patient, quarantine for not less than twenty-one (21) days after the be- 
ginning of the disease. Exclusion of the patient and children associated 
with the patient, from school for ten days after removal of quarantine. 
Other children of the family may, at the discretion of the health officer hav- 
ing jurisdiction, be disinfected and removed to another house and shall there 
be isolated and excluded from school for a period of ten days and then re- 
leased, provided they remain free from the disease. For adults living in 
the family with or exposed to the patient : — While the house remains quar- 
antined, unless said adults submit to thorough disinfection of the body and 
clothing and do not come in contact with the patient. 

DIPHTHERIA. For the patient, quarantine untilthe secretions from 
the nose and throat are free from the diphtheria infection as shown by 
bacteriological examination of such secretions. For children associated 
with or in the family with the patient, quarantine until death or recovery 
of the patient and disinfection of person, clothing and premises : Provided, 
That other children of the family who shall receive an immunizing dose of 
antitoxin of not less than 1,000 units, may be released from quarantine at 
the discretion of the health officer having jurisdiction, after disinfection of 
person and clothing. The patient shall be excluded from school until a med- 
ical certificate that the nose and throat are free from infection, based upon 
bacteriological examination, is furnished. Children associated with or in 
the family with the patient shall be excluded from school for seven (7) 
days after release from quarantine unless a medical certificate of having 
received an immunizing dose of not less than 1,000 units of antitoxin is 
furnished. Adult members of the family may be released from quaran- 
tine on the condition that they be disinfected in person and apparel and 
remain away during the quarantine period. 

EPIDEMIC CEREBRO=SPINAL MENINGITIS. For the patient, 
isolation from the rest of the family and quarantine for not less than 
fourteen (14) days after the first appearance of the disease until death or 
recovery of the patient and disinfection of the premises. Persons living in 
a house where the disease is present shall not mingle with the general 
public until the disease has terminated and the premises have been thor- 
oughly disinfected. And children from said house shall be excluded from 
school during the quarantine period. 



13 

MEASLES. For the patient, isolation and quarantine for not less 
than fourteen (14) days and until peeling or desquamation has ceased. Pa- 
tient shall not be permitted to attend school for five (5) days after quar- 
antine has been removed. For other members of the family, quarantine is 
not required, but children in the household must not attend school or other 
public gatherings or mingle with other children unless satisfactory proof 
shall be furnished to the health officer having jurisdiction of their having 
had the disease, in which event the said health officer may, at his discretion, 
permit the said children to attend school and other public gatherings. 

WHOOPING=COUGH. For tne patient, isolation and quarantine for 
not less than five (5) weeks from the beginning of the disease and until 
the "whoop" has entirely ceased. For other members of the family quar- 
antine not required, but Children of the same household must not attend 
school or other public gatherings or mingle with other children, unless 
satisfactory proof shall be furnished of having had the disease, in which 
event the health officer having jurisdiction, at his discretion, may permit at- 
tendance at school. 

CHICKENPOX. For the patient, quarantine for not less than four- 
teen (14) days from the beginning of the disease and until all scales and 
crusts have disappeared. Children living in houses where the disease ex- 
ists are to be excluded from school two (2) weeks unless satisfactory proof 
of having had the disease is furnisned. 

EPIDEMIC POLIOMYELITIS. For the patient, isolation and quar- 
antine for not less than twenty-eight (28) days from the beginning of the 
disease. For other members of the family, at the discretion of the health 
officer having jurisdiction: Provided, That the wage earners may be al-" 
lowed to attend to their work by observing the precautions recommended by 
the health officer. Other children in the family shall not be permitted to 
attend school or public gatherings or to mingle with other children for a 
period of fourteen (14) days after the beginning of quarantine. 

Rule 5. When it is known that a person has attended school 
while suffering from any of the following named diseases : Measles, 
scarlet fever (scarlatina), diphtheria (membranous croup), small 
pox, epidemic cerebro-spinal meningitis, epidemic polomyelitis 
cholera, or bubonic plague, the local health officer shall cause the 
schoolroom occupied by such person to be thoroughly disinfected 
according to the rules of the State board of health, before being 
used again for school purposes. 

Rule 6. When a case of contagious disease is reported it shall 
be the duty of the health officer having jurisdiction to ascertain the 
schools attended by any children from the infected premises and to 
serve notice upon those in charge of such schools, requiring that all 
persons from such infected premises be excluded from the school 
until a medical certificate or a written permit from the health officer 
is presented 



i7 w 

Rule 7. When a person affected with any of the quarantinable 
diseases has recovered and is no longer able to communicate the 
disease to others, or has died, the attending physician shall notify 
the health officer, and as soon thereafter as the health officer deems 
it advisable the house in which such person has been ill and the 
contents thereof shall be thoroughly disinfected by the health of- 
ficer or his deputy. 

Rule 8. The sale or use of milk or dairy or food products from 
the premises where one of the quarantinable diseases exists or 
where typhoid fever is present is strictly forbidden unless the milk, 
dairy or food products are handled, cans" and pails washed and 
stock cared for by persons entirely segregated from the affected 
person and family, and then only upon permission of the local 
health officer. 

Rule 9. No milk bottles shall be taken from premises on which 
a quarantinable disease exists until after the quarantine has been 
raised and said bottles have been thoroughly cleansed and disin- 
fected by the proper health officer. Milk tickets and bread tickets 
shall not be taken from such premises, but shall be destroyed. No 
mail matter shall be taken away from such premises while the 
premises are under quarantine. Cats and dogs and other domestic 
animals belonging to premises under quarantine shall be kept out 
of the house and from contact with the patient. Should these pre- 
cautions not be observed strictly, it shall be the duty of the health 
officer to cause such domestic animals to be destroyed. 

Rule 10. The body of a person who has died of any of the 
quarantinable diseases mentioned in Rule 1 shall not remain un- 
buried for a longer period of time than twenty-four (24) hours 
after death, unless embalmed and thoroughly prepared by a licensed 
embalmer. The undertaker or persons acting as such shall be re- 
sponsible for any violations of the provisions of this rule. 

Rule 11. All services held in connection with the funeral of 
a body of a person who has died of any of the diseases mentioned 
in Rule 1 shall be private. The attendance thereat shall include 
only the immediate adult relatives of the deceased, the necessary 
number of adult pallbearers, the minister and undertaker. Such 
services shall be held only in the home and any advertisement of 
such funeral shall state the cause of death. 



DIRECTIONS FOR SCHOOLHOUSE DISINFECTION. 



The Sanitary Schoolhouse Law of 1911, under section 2, pro- 
vides that "All schoolhouses shall be especially cleaned and disin- 
fected each year before they are opened for school purposes. The 
cleaning shall consist in first sweeping, then scrubbing the floors, 
washing the windows and all woodwork, including the wooden parts 
of seats and desks, and the disinfecting shall be done in accordance 
with the rules of the State board of health. ' ' The rules of the State 
board of health provide that disinfection of schoolhouses shall be 
done as follows: 

1. Carefully close all windows and doors, except one door for 
exit. Paste paper over stovepipe holes, and apply wetted paper or, 
better, paste paper strips over all windows, transom or door cracks. 
In a word, seal the room tightly with paper strips from the inside. 

2. Open closet doors, drawers, trunks, boxes, etc. Suspend 
clothing upon lines stretched across the room, or spread out on 
chairs or clothes horse. All books must be opened and the leaves 
spread. In short, the room and its contents must be so disposed as 
to secure free access of gas to all parts and all objects. 

3. Make the air in the room damp ; this is absolutely neces- 
sary for disinfecting by formaldehyde. Dampness may be pro- 
duced (a) by boiling water on a gas, gasoline or oil stove; (b) by 
pouring boiling hot water from a teakettle into a tub; (c) by pour- 
ing hot water onto bricks or stone, or by dropping hot bricks 
or stones into vessels containing water. Under no circumstances 
is efficient disinfection possible without in some way making the 
air of the room quite damp. 

4. Measure the room and multiply the length, breadth and 
height together. This will give the contents in cubic feet. Divide 
by 1,000, and this gives the number of thousand cubic feet in the 
room. This is called the unit space. 

5. Measure the room, and for each 1,000 cubic feet (unit space) 
use two pints of formaldehyde and three and one-half ounces of 
commercial permanganate of potassium. Procedure : Place a large 
washbowl, crock, tin dishpan or galvanized iron pan or tub in the 
center of the room. Put in the required amount of permanganate 
of potassium and lastly, pour in the required amount of formald<> 



16 

hyde. Permanganate must be put in first. Retire immediately 
after pouring in the formaldehyde, for the formaldehyde gas is 
promptly released and is injurious if breathed in any quantity. 
Keep the room closed for at least three hours, then open, air thor- 
oughly, and clean in the usual way. 

Solidified formaldehyde may be used for gaseous room disin- 
fection, using not less than one ounce of solidified formaldhyde 
for each 1,000 cubic feet, not neglecting moisture. 



HEALTH SUPERVISION IN PUBLIC SCHOOLS. 



The necessity for careful supervision of the health and develop- 
ment of school children is no longer open to argument. The people 
themselves are demanding such supervision as the most vital func- 
tion of the public school system, so that no school can any longer 
claim a place in modern educational progress which ignores or 
neglects the health conditions of its pupils. In the light of present 
knowledge concerning the health of school children, it may be said 
that a community which neglects a systematic health care of its 
school pupils is guilty of criminal negligence. If all parents were 
sufficiently wise in health matters it would probably be unneces- 
sary for schools to make any special study of the physical condition 
of the children entrusted to their care. But it is a fact, and not 
a theory, that not all nor even most parents are wise in matters 
pertaining to the health condition of their children. It becomes, 
therefore, the plain duty of the school department to furnish not 
only a healthy school environment, but also a careful guardianship 
of the personal health of its pupils. 

Medical supervision includes far more than inspection. It 
means a health study in a broad sense of the pupils in the schools, 
with an attempt to adjust them to their physical environment. It 
means a study of the condition of sight, hearing, an examination 
for evidence of nasal obstruction, diseased tonsils, seriously de- 
fective teeth, disorders of nutrition and development, unbalanced 
nervous organism, for signs of early heart or lung disease, for en- 
larged glands, skin diseases, and symptoms of children's common 
contagious diseases. It means the careful physical study of school 
children, for it has been shown clearly that there is an intimate 
relation between the child's -physical condition and his mental 
progress and future success. 

Facts obtained from actual observation in many different schools 
of Indiana show that of all the pupils in the public schools below 
and including the eighth grade, 60 per cent, suffer from some 
physical defect that to a greater or less degree impairs their mental 
efficiency ; that fully 25 per cent, of all grade pupils have diseased 
tonsils ; that 18 to 20 per cent, have defective vision ; that 15 per 
cent, have adenoids; that 8 to 10 per eent. have defective hearing. 

(17) 



IS 

and that fully 35 per cent, have defective teeth to such an extent 
as to impair nutrition, thus seriously decreasing their mental ef- 
ficiency. In the face of these facts no argument is needed in favor 
of medical school inspection. 

All who are interested in health inspection realize that it will 
cost. All good and desirable things do cost. We have long since 
recognized the need of properly inspecting our domestic animals, 
and we gladly pay the cost for this work. The children of a State 
are truly its most valuable asset. We, therefore, should not only 
be willing but anxious to pay whatever is necessary for their care. 
Medical inspection of school children looks to the future as well as 
to the present. By relieving and removing present defects it pre- 
pares for a stronger nnd sturdier body of citizens in the near future. 
In order to bring about such a result the citizens of the present 
should willinsrlv make the needed investment 



MEDICAL SCHOOL INSPECTION LAW. 



AN ACT entitled an act to protect and conserve the health and lives of 
school children and promote their efficiency by providing for their medi- 
cal inspection and subsequent necessary treatment. 

(H. 27. Approved March 6, 1911.) 

Schools — Medical Inspection of Children. 

Section 1. Be it enacted by the General Assembly of the State 
of Indiana, That all school trustees and township trustees are here- 
with permitted and recommended to institute medical inspection 
of school children at any time ; the said trustees may require teach - 
erg to annually test the sight and hearing of all school children 
under their charge, the said tests and uses thereof to be made 
according to the rules hereinafter authorized. 

Medical Inspection Defined. 

Sec. 2. The term, medical inspection, as used in this act, shall 
be held to mean the testing of the sight and hearing of school 
children and the inspection of said children by school physicians 
for disease, disabilities, decayed teeth or other defects, which may 
reduce efficiency or (ond to prevent their receiving the full benefits 
of school work. 

School Physician — Appointment — Compensation. 
Sec. 3. Beginning with the school year 1911, school trustees 
and township trustees may appoint at least one school physician 
for each school corporation : Provided, Where practicable, two or 
more school corporations may unite and employ one such physician, 
whose duties shall bo such as are prescribed in this act and the 
authorized rule*, bul no physician shall have more than 2,000 
school children under his charge. Said school physicians shall be 
graduates of a medical college, recognized by the State board of 
registration and examination, shall hold a license to practice medi- 
cine in Indiana, and shall be informed and skilled in medical inspec- 
tion of children, informed in the health laws and the health rules of 
the State board of health, shall be temperate, able-bodied, cleanly in 
person, not addicted to drugs, and of good moral character, and 
no others shall be appointed. School physicians may be discharged 
by the appointing power at any time. School physicians shall 
8 p r vp one year and until their successors are appointed, and shall 



-• - 20 

receive such compensation as the appointing trustee or trustees 
may determine. 

Physician's Duties. 
Sec. 4. School physicians shall make prompt examination and 
diagnosis of all children referred to them and such further exam- 
ination of teachers, janitors and school buildings as in their opinion 
the protection of the health of the pupils and teachers may require. 
Whenever a school child is found to be ill or suffering from any 
physical defect, the school physician shall promptly send it home, 
with a note to parents or guardians, briefly setting forth the dis- 
covered facts, and advising that the family physician be consulted. 
If the parents or guardians are so poor as to be unable to give the 
relief that is necessary, then school trustees and township trustees, 
as the case may be, shall provide the necessary relief : Provided, 
That in cities where public dispensaries exist the relief shall be 
given by said dispensaries. School physicians shall keep accurate 
card-index records of all examinations, and said records, that they 
may be uniform throughout the State, shall be according to the 
form prescribed by the rules authorized in this act, and the method 
and manner of reports to be made shall be according to said rules : 
Provided, however, That if the parents or guardian of any school 
child shall at the beginning of the school year furnish the written 
certificate of any reputable physician that the child has been ex- 
amined and parents notified of the results of such examination in 
such cases the services of the medical inspector herein provided 
shall be dispensed with, and such certificate shall be furnished by 
such parent or guardian from time to time, as required by the 
trustee or board of trustees having charge of such schools. 

Rules for Enforcement. 

Sec. 5. The State board of education and the State board of 
health shall jointly pass rules for the detail enforcement of the 
purposes of this act, which rules shall bear the printed seals of 
said boards ; the said rules to be printed and promulgated by the 
State printing board; promulgation to consist in supplying a rea- 
sonable number of copies to each county superintendent, from 
whom all who are interested may procure a copy. 

Penalty. 

Sec. 6. All violations of this act, except as otherwise provided, 
shall b? pnniahArJ by » finp of nnj loos than ten or more thin fifty 



RULES FOR MEDICAL SCHOOL INSPECTION. 



THE SCHOOL PHYSICIAN. 

Rule 1. It shall be the duty of the school physician to ex- 
amine all school children as soon as practicable after their first ad- 
mission to school. This examination shall take note of said children 
as to cleanliness, obvious physical defects, as physical deformities, 
condition of nose and throat, and teeth, ear discharges, squints, gen- 
eral fitness for school life and previous medical history. Measure- 
ment of height and weight shall be recorded. This first examination 
shall be conducted in the presence of the parents or family physi- 
cian, if so desired. (Provided, that any child presenting a certifi- 
cate of examination as provided in the medical inspecton law, shall 
be exempt from the school ph'yscian's examination.) A permanent 
record of all such examinations shall be kept on blanks, according to 
form prescribed by the State board of education and State board 
of health. Such records to be subject to inspection by the public 
only on an order from the school physician. 

Rule 2. It shall be the duty of the school physician to make 
an examination of all children referred to him by teachers. Such 
examination to consist of whatever may be necessary to determine 
whether or not the child should be excluded from school. Such 
examination shall be made in the presence of the parents if so de- 
sired. In all matters pertaining to exclusion from school the de- 
cision of the school physician shall be final. A. record shall be kept 
of all such examinations on forms shown in this manual, to be pro- 
vided by the school authorities, a copy of which shall be furnished 
the parents or guardian of said children. 

Rule 3. It shall be the duty of the school physician to make 
a general examination of all the children in the public schools at 
least once a year for any defect or disability tending to interfere 
with their school work, and a special examination of children (a) 
who show signs of being in ill health or of suffering from infec- 
tious or contagious diseases (b) who are returning to school after 
absence on account of illness or from unknown cause. 

Rule 4. It shall be the duty of the school physician to make 
such examinations of teachers, janitors and school buildings as in 
his opiDi^n l"-h*» jvrntpptinn of Hip health of thp pupils may rpqrnro 



22 

RULES FOR TEACHERS. 

The teachers in all the public and parochial schools of the State 
of Indiana shall test the sight and hearing of all school children 
under their charge, once in each school year, and at such other 
times as may be necessary. The sight test shall be made by the use 
of the Snellen's Test Type Chart and the hearing test shall be by 
the watch test or the whisper test, preferably the whisper test. An 
individual record shall be kept of said test and whenever a defect 
of vision or hearing is noted the case shall be referred to the school 
physician. Teachers and school officials shall rigorously exclude 
from school all children specified in any notice of exclusion issued 
either by the school physician or by the local health officer until 
such children shall present a certificate of admission from the school 
physician or the health officer. 

RULES FOR TESTING EYESIGHT. 

Rule 1. The annual test for eyesight and hearing shall be 
made as early in the school year as possible, preferably in Septem- 
ber. Individual pupils may be tested at any time that a test is 
considered necessary. 

Rule 2. All tests shall be made as nearly as possible under 
the same conditions and shall be supervised by the principal or 
superintendent, in order to see that the conditions of the test are 
uniform as far as possible for the different classes. 

Rule 3. Do not expose the test type chart except when in use, 
as familiarity with the chart leads children to learn the letters "by 
heart." Children should be examined singly. 

Rule 4. Test each eye separately. Have the pupil begin at the 
top of the test card and read down as far as ho can, first with one 
eye and then with the other. Hold a card over one eye while the 
other is being examined, but do not press on the covered eye, a« 
pressure may produce an incorrect examination. 

Rule 5. Place the test chart on the wall in a good light at 
about the level of the pupil's head and at a measured distance of 
20 feet from the pupil. The chart should have a good side illumina- 
tion and not hang in range of a window, which will dazzle the eyes. 

Rule 6. Children wearing glasses shall be tested with the 
glasses properly adjusted, and if sight is found normal with the 
glasses it shall be recorded as normal 



23 

Rule 7. Record as defective only those whose vision is 10-20 
or less in either eye. 

Rule 8. Where the child cannot name the individual letters, 
although able to read, the chart figures may be used. If the child 
does not know figures or letters, use the chart of inverted E's, 
asking the child to tell by the movement of the hand the side on 
which there is an opening on the E's, i. e., up, down, right or left. 

Rule 9. The lines on the chart are numbered to indicate the 
distance the respective letters should be read by the normal eye. 
The record is made by a fraction, of which the numerator repre- 
sents the distance of the chart from the child and the denominator 
the lowest line he can correctly read. Thus, if at 20 feet the pupil 
reads the line marked 20 feet, the vision is 20/20 or normal. If he 
only reads correctly the line above marked 30 feet, his vision is 
20/30 or 2/3 normal. If at a distance of 20 feet the pupil can only 
read correctly the line marked 40 feet, the vision is 20/40 or 10/20, 
which must be recorded as defective. 

If a pupil cannot read the largest letters he must go slowly 
toward the chart until he can. The distance he is from the chart 
when he can read the largest letters will be the numerator and 
200 the denominator. 

Rule 10. Report to the State board of health the total number 
of children examined and the number found defective in eyesight 
and hearing by test. 

METHOD OF TESTING HEARING. 

The person conducting the test should be possessed of normal 
hearing. The examination should be conducted in a room not less 
than 25 feet long and situated in as quiet a place as possible. The 
floor should be marked with parallel lines, one foot apart and num- 
bered. The child should sit in a revolving chair in the first space. 
Examination should be made with the whisper or spoken voice. 
The child should repeat what he hears and the distance at which 
words can be heard distinctly should be noted. The two ears 
should be tested separately. The test words may consist of num- 
bers from one to one hundred and short sentence. It is best that 
but one pupil at a time be allowed in the room, to avoid imitation. 
The standard to be adopted is as follows : In a still room the stand- 
ard whisper can be heard easily at 25 feet. The whisper of a 
low voice can be heard from 35 to 45 feet and of a loud voice 50 
to RO feet 



24 

In the watch test the ticking of a watch is used instead of the 
voice. The watch test, however, cannot be depended upon for the 
reason that children when asked if they hear the ticking of a 
watch will answer, "Yes," when in fact they do not hear the 
watch. For this reason the whisper test should be used. 

BLANK FORMS. 

The following blank forms are recommended for use in connec- 
tion with the institution of school inspection, in order that the 
system of supervision and records may be uniform wherever med- 
ical inspection is established throughout the State. Additional 
blanks and forms may be added by school officials to meet local 
conditions, or as the scope of medical supervision may be en- 
larged. The forms herein given will be found essential and are to 
be adopted as the basis of record wherever medical inspection is 
instituted. 



25 



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27 

The above form is for a complete physical and scholarship rec- 
ord of the pupil while enrolled in the schools. This requires a card 
6x16 inches, perforated to fold lengthwise, the inside blank space of 
the folded card to be used for writing the details of physical ex- 
aminations, with the record of treatment and results. 

Both forms shown above are to be printed on one card. 



No. 3. 

NOTE TO SCHOOL INSPECTOR. 



Name 

Residence 

School 

Please examine this pupil for' 



Teacher. 

When out of Blanks notify 



No. 4. 

School Health Depastment. 19 . 

TO THE PARENT OR GUARDIAN OF 



It is my duty to report to you the result of an examination of the above 
named. 



You are advised to take to a physician for further advice and 

treatment. Be sure and 

TAKE THIS PAPER TO THE DOCTOR. 



Medical Tnspeciw of Schools 



No. 5. 



28 

School 19. . . 

TO THE PARENT OR GUARDIAN. 

was sent home from school because 

the child's body was not clean, 

the head was not clean, 

the clothes were not clean. 
The child must not be sent back to school until clean. 



.Principal. 



No. 6. 



Department of School Inspection. 
, . .Public Schools. .19. . 



Principal: 
Admit 



Medical Inspector. 



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30 

School Health Department IB. . . 

TO THE PARENT OR GUARDIAN 

of 

It is my duty to report to you that 

has been examined by the school inspector — or dentist — and that 

teeth need cleaning—treatment — filling. 

Please Secure Competent Dental Advice at Once. 

Teacher. 

School Health Department. 19 . . . 

NOTICE TO PARENT OR GUARDIAN. 
You, are hereby notified that 

has been examined by the school inspector and found to have symptoms 

of 

Please Secure Competent Medical Advice at Once. 

Teacher. 

School Health Department. 19. . . 

NOTICE TO PARENT OR GUARDIAN. 

You are hereby notified that the school examination of 



shows some trouble with the ears which needs competent medical advice. 

eyes 

Please Attend to This at Once. 
Teacher. 



:n 



BLANK FORM FOR REPORT TO STATE BOARD OF HEALTH OF 
RESULT OF EYESIGHT AND HEARING TEST. 



School Health Department. 



19. 



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Hearing 


Grade 


Number Examined 


Number Defective 


Grade 


Number Examined 


Number Defective 


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2 






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Superintendent. 



TEACHING OF HYGIENE. 

As provided in section 3 of the Sanitary Schoolhouse Law, the 
State health commissioner and State superintendent of public in- 
struction have prepared a series of pamphlets upon hygiene and 
sanitary science, which are to be used in connection with the works 
on physiology and hygiene adopted by the State board of educa- 
tion. These supplemental pamphlets will be sent out from time to 
time to county and city superintendents, to be distributed to teach- 
ers as provided in the Sanitary Schoolhouse Law. 



SOME COMMENTS ON THE INDIANA SANITARY 
SCHOOLHOUSE LAW 



The purpose of the Indiana Sanitary Sehoolhouse Law, as stated 
in the preamble to the law, is "to protect the health and lives of 
school children and increase their efficiency." While the law is 
specific in every particular, it is manifestly impossible to enact a law 
that will cover every detail and provide for the many and varied 
local conditions that may arise. It is the purpose of this article to 
go into details in a brief way and, if possible, make plainer the pur- 
poses and provisions of the law. 

(a) Site. The selection of the site for a school building has an 
important bearing upon its hygienic condition. The land on which 
a sehoolhouse is built should always be high and dry, with every 
precaution taken against dampness in the basement or about the 
building. There are many diseases not directly due to dampness, 
but which are fostered by its presence, particularly diphtheria, ty- 
phoid fever, rheumatism and consumption. A sehoolhouse should 
never be located upon "made ground," that is, upon ground that 
has been filled in with ashes, rubbish, or animal or vegetable refuse. 
The air and moisture arising from such land will contain foul gases 
which are bound to make their way into the basement and building. 
The best soil for a sehoolhouse site is gravel. Next in order of pref- 
erence is a sandy soil and then sandy clay. Unmixed clay soil re- 
tains moisture very readily and basements dug in such soil are very 
likely to be damp. A sehoolhouse should be far from confusing 
noises, such as those made by trains and factories. There are 
numerous instances of school buildings in Indiana located so near 
railroads that it is necessary to postpone school work whenever a 
train passes. The reason for a provision in the law which prohibits 
a school building being located nearer than 500 feet to any noise- 
making industry or any unhealthful condition is plainly obvious. 
The school building, as a general rule, should not cover more than 
one-half the school lot. A good rule to follow is that no adjoining 
structure should be nearer than twice the height of the school build- 
ing. The' necessity for ample playgrounds is now generally recog- 
nized. In laying out a school yard at least 30 square feet should be 
allowed for each pupil. -Rural school yards should be one acre or 

(32) 



33 

more in extent. Very frequently the choice of a school site is in- 
fluenced by mercenary considerations, so that a school is located in 
a particular spot because the land is cheap. The importance of 
hygienic considerations should rise above all other factors and it 
should be borne in mind always that no land is too good for school 
purposes. 

(b) Building. The Sanitary Schoolhouse Law deals with the 
school building only from a hygienic standpoint. The construction 
of a school building should receive as much attention from the sani- 
tary authorities as from the architect, and only when the two work 
together may we hope to see ideal school buildings. While the de- 
mands of different communities will require much variation in 
plans, yet there are many general principles that apply in all cases. 
The first consideration is a "dry, well-lighted basement"; not a 
dark, foul storage room for the accumulation of old rubbish, but a 
clean, well-ventilated and well-lighted room that can be used in 
stormy weather with safety as a playground for children. Such a 
basement besides, can be used as a laboratory, for manual training 
work, for gymnastics and in various other ways as the needs of the 
school may require. In order that plenty of light may be admitted, 
the top of the foundation must be at least three feet above the 
ground, and four feet is even better. School buildings should not 
be above two stories in height, for the reason that stair climbing is 
not advisable and may be injurious to growing girls, and because of 
the greater danger in case of fire. School entrances should be large, 
sufficient in number, and in all cases the doors should open outward 
and be fitted with automatic opening devices. Under no considera- 
tion should any outside door to a school building be fastened when 
school is in session, because of the danger of a crush in case of fire. 
Stairways should be not less than 5 feet in width with steps of uni- 
form shape, and equal width, the steps to be not more than 8 inches 
high. No flight of stairs should have more than 15 steps between 
landings. 

(c) Lighting and Seating. No obstruction to the entrance of 
light should exist outside the school building. The best light will 
be had where the longer axis of the building runs east and west and 
the windows are on the north and south sides only. For the best 
and most equal distribution of light the school rooms should be 
long and narrow with windows on but one side. The light from the 
left of the pupil is best because it falls on the desk without shadows. 
Most pupils are right-handed and are consequently annoyed by 



M 

light from the right causing shadows upon their work. Crossed 
light from both right and left is injurious. Light from the front 
dazzles the eyes. If the light comes from the rear, the pupil 's head 
causes shadows and the teacher faces the dazzling light. Windows 
should extend to within one foot of the ceiling for the reason that 
light from the upper part of a window is thrown farther in a room 
thus insuring more even distribution. Windows should extend not 
nearer than four feet from the floor to prevent the light from the 
lower part of the window shining upwards into the eyes of the pupil. 
The desks and desk seats. The average child is employed at 
school work about one-third of the entire working period from six to 
fifteen years of age. This is essentially the formative period in the 
child's life, during which the bones are undergoing a transformation 
from cartilage to fully matured bone. The proper seating of the 
child in school during this most important period becomes an urgent 
problem. The old-fashioned school furniture, in which the child is 
compelled to fit the seat and desk, thus involuntarily assuming an 
injurious position has been responsible for more near-sightedness, 
curvatures of the spine, difficulties of respiration and distortions of 
the body than any other one cause. The more common defects of 
school seats and desks are as follows : 

1. The desk too high for the child's sitting height, causing an 
elevation of one shoulder in attempting to write, with a correspond- 
ing lowering of the other shoulder, thus producing a tilt of the 
spinal column. 

2. The desk too low, causing the child to stoop forward. This 
produces round shoulders from continued stooping and interferes 
with circulation and respiration. 

3. Desk too far away from the seat, causing a stoop of the body 
with injury to the eyes and compression of the chest and abdomen. 

4. Seats too high so that the feet are not supported. 

5. Improper support for the back, causing fatigue and curva-" 
ture of the spine. 

6. Seat not suitably hollowed, causing pain and restlessness. 

7. A well-proportioned desk «nd seat, but not adapted to the 
size of the child using it. 

The remedy for these defects is the adjustable school desk and 
seat, properly modeled and properly adjusted to the pupil. Every 
pupil should have a desk and seat adjusted to him carefully with 
the adjustment changed once or even twice a year as required to 
allow for growth. Teachers may object to adjustable furniture. 



because of the trouble necessary in proper adjustment, and be- 
cause of the unsightliness of different heights of seats and desks 
in the same school room. These are trivial objections, and are far 
outweighed by the greater advantages of the child's proper growth. 
Two terms have come into use with adjustable school furniture, the 
1 ' distance ' ' and the ' ' difference. ' ' In adjusting seats and desks, the 
"difference" only is of importance. By this term is meant the 
vertical distance measured from the rear edge of the pupil's desk 
to the plane of the seat. The proper length of this distance should 
be equal to the space between the pupil's elbow and the seat bones, 
taken in an erect sitting posture. The height of the seat from the 
floor should correspond to the length of the pupil's legs from the 
sole of the foot to the knee. Especial care should be given to crip- 
pled children who are obliged to attend school. Those suffering 
with hip or knee diseases where the joints are immovable should be 
given a seat with a desk placed 8 or 10 inches further away than 
ordinary, to allow a greater range of motion. If one of the lower 
limbs be shortened, a small footrest should be supplied for the short- 
ened member. Cases of curvature of the spine, which are found 
often, can be made more comfortable by the use of a pad upon which 
to rest the back. All children who are afflicted in any way should be 
allowed more than ordinary privileges in moving about the room. 

(d) Cloak Room. Wardrobes and cloak rooms should not be a 
part of the school room. Outer garments of children frequently 
carry disease germs, and damp outer garments should never be 
allowed to remain in the same room with school children. A model 
cloak room should be separated from the school room, should be 
connected with the corridor and should have windows so arranged 
as to allow a considerable supply of fresh air to circulate about the 
clothes. It should contain individual compartments or lockers for 
each pupil's garments. In some schools there are drying closets 
attached to the cloak rooms, for use on damp and rainy days for 
drying wet shoes and outer wraps of the pupils. This is a most 
excellent arrangement and should be installed wherever possible. 
It would be of great service, especially in times of epidemics to have 
a small air-tight closet where garments, books and other articles 
brought from home to school could be thoroughly disinfected. 

(e) Water Supply and Drinking Arrangements. The neces- 
sity for a good, wholesome supply of drinking water in connection 
with all schools is obvious. This supply when not obtained from 
the regular city water supply should be from deep driven wells. 



36 

In this connection it may be well to know that a driven well is not 
safe unless made safe and kept so. Numerous instances have been 
noted where the well, although a deep driven well, had a gallery 
extending three or four feet beneath the surface, in no wise pro- 
tected from surface drainage and partially filled in many cases 
with stagnant, slimy water. There is absolutely nothing in such 
case to prevent this surface drainage from following down the cas- 
ing of the well and contaminating the source of water supply. All 
wells, whether driven or otherwise, should be thoroughly pro- 
tected from any possibility of surface contamination. The com- 
mon drinking cup, the filthy, saliva-coated, germ-laden, tin cup or 
dipper, now very properly known as "the death cup," together 
with the equally filthy, rusted, plague-spotted water pail, should 
not be tolerated for one day in a school room. Wherever possible 
the bubble fountain should be installed. Where fountains are 
impossible, an earthen or enameled water container with a spring- 
faucet should be used, and each pupil should have a marked cup 
for his own use and that only. The question of each pupil using 
only his own cup is a matter of discipline in connection with which 
the responsibility of the teacher is apparent. No common towel 
should ever be allowed in a school. Contagious skin diseases and 
affections of the eye find ready interchange by use of the towel. 
Sanitary paper towels are both cheap and convenient. No other 
kind should be considered. 

(f) Heating and Ventilation, (a) Heating. The tempera- 
ture standard for school rooms given in the sanitary schoolhouse 
law as a minimum is 70 degrees. As a matter of fact 70 degrees 
should be the maximum. A uniform temperature of 68 degrees, 
with the air of a school room properly humidified, is far better 
than 70 degrees. Two thermometers should be placed in every 
school room, one at the farthest point from the stove, registers or 
radiators. The temperature should not vary more than three de- 
grees in any part of the room. The methods of supplying heat 
are two: direct and indirect. By direct is meant when the heat 
supplying force is contained within the room itself as a stove or 
the registers of a steam or hot water plant. When a stove is used, 
great care should be had to see that no gases are given off and that 
the heat is not too intense for those nearest the stove. For the 
protection of pupils who must sit near the stove and in order to 
prevent them from becoming ''over done," fire screens should be 
used. These screens should always be constructed of two layers 



37 

of metal with a layer of asbestos or space for air between. Indi- 
rect heating 1 consists in warming fresh air outside the room then 
introducing- this warmed air into the room. Three methods of 
indirect heating are in general use : steam, hot water and warm air 
furnaces. One or the other of these indirect systems should always 
be used when possible. The important point favoring the warm air 
system is the. simplicity of its operation. After all, the most im- 
portant part of any indirect system of heating is the janitor or 
engineer in charge. The average school janitor is selected because 
of his inability to perform any other work and because he can thus 
be employed at a saving of dollars and cents, too often without 
regard for the health and lives of the school pupils. A janitor 
should always be selected with as much care as a teacher, should 
be fully equipped for his work and invariably sober and indus- 
trious 

(b) Ventilation. In spite of the fact that the dangers of illy- 
ventilated rooms have been widely discussed by sanitarians and 
educators and the State Board of Health has passed, rules and 
issued orders protesting against lack of fresh air in school rooms. 
it is nevertheless true that in hundreds of school rooms in Indiana 
the air is not so pure as in the ordinary stable. Most of these 
rooms are in buildings constructed years ago when no other means 
was provided for changing the air than is afforded by doors and 
windows. The sanitary schoolhouse law seeks to provide better 
ventilation in the school rooms of the future by establishing a fixed 
compulsory standard of fresh air supply. The problem of supply- 
ing fresh air would seem, simple enough, for there is an abundance 
of fresh air in the world. The difficulty comes in bringing about a 
constant exchange of outside fresh air for inside foul air without 
causing draft. Two methods of artificial ventilation are permiss- 
ible, the gravity system by which the currents of air are kept in 
motion by the difference of weights of hot and cold air; and the 
fan system by which the air is circulated in the rooms by means of 
a forced draft from a rotary fan There can be no question as. to 
the relative merits of these two systems, especially in buildings 
with more than six rooms. The fundamental principle of school- 
'room ventilation has been expressed as follows : "If a given 
amount of air is required in a given space, in a given time, it must 
be put there, not allowed to go there." Because the rotary; fan 
will "put" a given amount of air whenever and wherever it. is 
required, the fan system of ventilation should always be installed 



in any school building containing more than six rooms. la smaller 
buildings, those containing six rooms or less, a system of gravity 
ventilation with openings of sufficient size to admit fresh air and 
with ample ducts to carry off the foul air will be found satisfactory. 
All openings for the intake or exit of air should lead directly to the 
outside of the building, never opening into the basement or attic, 
as can now be found in hundreds of school buildings thr©ughout 
the State. 

(g) Water Closets and Outhouses. The proper placing of 
water closets is often a difficult matter and one about which there 
is much difference of opinion. Whenever possible, closets should 
be placed in the building. When closets are located outside the 
building, many children will refuse to respond to the call of nature,' 
on account of exposure to cold, and in consequence of delay will 
suffer from constipation, hemorrhoids, etc The best closet for all 
grades is one that is flushed every time it is used, either by means 
of a chain and pull or by a mechanical device that operates when 
the weight of the body is taken from the seat. The principal 
source of trouble is to be found in securing a satisfactory urinal for 
boys. This* should alwa} r s be constructed of impervious material, 
such as slate, cement or porcelain, should be trough-like in shape 
with a continuous and strong flow of water through it. The floor 
should be of a similar impervious material for at least six feet from 
the urinal with a perceptible slope forward toward a drain, in 
order to be easily and thoroughly flushed. Where sewerage is im- 
possible a dry closet system if properly installed will be found 
satisfactory, especially if burned out every day. In country 
schools the dry earth closet, if properly attended, serves every 
purpose admirably. Here again, the question of proper care of 
closets of whatever kind is largely a matter of discipline for which 
the teacher is responsible. Children should be taught that nui- 
sances in closets whether from a moral or sanitary point of view 
will not be tolerated. 

Disinfection. The various so-called "automatic" disinfecting 
appliances so frequently found in school rcoms and so highly rec- 
ommended as a sure preventative of all contagious diseases (by the 
agent) are a delusion and a snare. Mostly (when they do any- 
thing) the3 r give off a disagreeable odor, which like the ancient 
asafcetida sack, creates a false sense of security. All such appli- 
ances are absolutely without value. Many janitors and school trus- 
tees place too much reliance on disinfectants, seeming to think that 



39 

no matter how filthy a corner may be, a liberal sprinkling &i lime 
or wood ashes will immediately purify it. The best disinfectant 
always and everywhere is cleanliness. 

Scrupulous cleanliness should be the "first relief" in every 
case, to be applied in advance of other means. 

The Janitor and His Duties. The janitor is by far the most 
important official connected with the school. As has been indicated 
above, the efficiency of any artificial system of heating and ventila- 
tion depends fully as much on the knowledge and care of the janitor 
in charge of the system as upon the mechanical correctness of the 
system itself. It seems more than strange that school authorities 
will often place the welfare of the children of a community in the 
hands of a man so ignorant and incompetent that the same school 
authorities would not trust a team of horses in his care at any 
price. In the first place, janitors should be well paid, for their 
work is important. In the second place the qualifications of. a 
janitor should be scrutinized as carefully as the qualifications of a 
teacher. In the third place, the instructions issued to janitors 
should be specific, covering every part of their work, and the work 
should be systematized and thoroughly understood by the school 
officials and janitors. The janitor should not live in the school 
building. The necessary accompaniments of housekeeping, such 
as cooking, laundry work, domestic pets, etc., have no place in the 
average school building and are a source of annoyance and positive 
injury. Dry sweeping and feather clusters should be prohibited. 
No sweeping should be permitted, either in corridors _or rooms when 
school is in session. Janitors should be thoroughly instructed ia all 
the requirements of heating and ventilation and should thoroughly 
understand every mechanical appliance connected with the system 
under their care. An anemometer (an instrument for measuring 
the volume of air entering or leaving a room) should be a part of 
the equipment of every school corporation, where artificial ventila- 
tion is in use. Janitors should not be permitted to leave brooms, 
stepladders, or tools of any kind, standing in corridors, stairways 
or behind doors. Besides forming convenient places for the accu- 
mulation of dust and dirt, such things in hallways and exits might 
easily become a serious obstacle in the way of escape in case of fire. 

Pencils. The argument against the common drinking cup and 
the common towel, applies with equal force to the common use of 
pencils. Frequently pencils are given out to pupils in the morning 
and taken up in the evening. No system of marking these pencils 



40 

•can prevent mouth contamination and possible interchange of 
pencils. When a pencil is given to a pupil, the pencil should be the 
individual property of that pupil, to be kept in his desk and not 
taken up and given out again by the teacher. The slight increased 
expense incurred in replacing pencils carried away and lost is 
trivial, when compared with the clanger of transmitting disease 
from one pupil to another in the indiscriminate interchange of 
" chewed" pencils 

Care of Floors. The Use of oil on school room floors will over- 
come the "dust nuisance" to a very great extent. Experiments 
show that proper application of oil decreases the bacteria count in 
the air and dust of .school rooms from 55 to 250 per cent. All 
school room floors should be oiled from two to four times a year 
as required. 

Humidity of Air. The air of school rooms should always be 
"humidified," that is, moisture should be added. Where heating 
and ventilating systems are installed, an air washing device should 
be included in the system. AVhen "direct-indirect" heating is used. 
shallow pans to hold water for evaporation placed on the radiators, 
answer a good purpose. Where stoves are used, a kettle contain- 
ing water should be kept on the stove. 

No law can create efficiency, but may point the way to efficiency. 
An intelligent interpretation of the sanitary sehoolhouse law, with 
an intelligent application of the principles of school hygiene con- 
tained therein will do much to make the schools of Indiana what 
they should be, namely : the crystallized intelligence and sentiment 
of the State toward its future citizens. 



MAO 

I NY 



